Chain drugstores: Opportunities and Threats.

Affecting the Economy of Independent PharmaciesOne can never deny the influence of chain pharmacies as a powerful competitor over the economy of independent pharmacies. In one view, integrating independent pharmacies with low turnover into chain pharmacies can save them; On the other hand, chain pharmacies can lead to more treat for independent pharmacies life.Patient costsIt is expected to decrease Price of non-prescription and generic drugs and give a discount on generic drugs, which lead to decrease in the consumers’ drug expenses. But in many countries this is not the case. Although there is a more bargain power in chain pharmacies, the decrease in the consumer price is dependent upon the monitoring and controlling of pharmacy profit margin.Health Section CostsIn chain pharmacies, due to the increase in the market power and monopoly, induced demand will increased, and because of the selling more non-prescription medicines and supplements, the general health system cost is increased.ConclusionDue to the economical incentives, Chain pharmacies would not be avoidable and even though the legal limitation, they have been established illegally. As mentioned in this report, Chain pharmacies have some advantages and disadvantages and through a proper regulation and supervision, we can welcome its advantages and reduce disadvantages. Nevertheless, By keeping silent against this illegal phenomenon, society would bear disadvantages while being deprived of its possible advantages.

Accessibility of the pharmacy Due to increase in the total number of pharmacies, accessibility increase. But it does not happen all over the country. Despite the number of pharmacies increase in the urban areas, rural and faraway areas face to drop in number of pharmacies. So in chain pharmacies› regulation, care should be exercised to avoid this problem by obligation of establishing chain in the rural areas (such as in Australian regulation).

Accessibility to the prescription drugs
In vertical integration due to the distributors› dominance, and in the horizontal integration due to the economical profits, high prescribed drugs are always available while rare drugs remain rare and it would be worse in the rural areas.

Drug accessibility
In case of lack of proper regulation and supervision, due to the above mentioned reasons and tendency to sale non-medical items by higher profitability, drug accessibility would decrease.

Personnel quality
Powerful organization of Chain pharmacies enables them to employ high quality personnel. They can also could establish higher standards and train their personnel. However, in the lack of proper supervision, pharmacists are faced to problem for finding proper job and their professional creativity decrease. Empowerment of pharmacy owners and monopoly affect professional independence of pharmacists and fade roles.

Service quality
Some believe that lack of attention towards the prescription drugs and increase in the sales of non-prescription medicines and non-pharmaceutical products in spite of higher internal standards leads to poor quality of drug services. High load of work in chain pharmacies, lead to decrease in medical counseling; whereas, in independent pharmacies, due to a sole-ownership policy and fixed management quality of the services will sustained in the course of time. Meanwhile, some others believe that the quality of services in chain pharmacies is surely increased due to the economical power for employing more pharmacists by more payment. patient pay more attention to pharmacists because of the better services provided, and there is more inclination to paying counseling fee to the advising pharmacists compared to the independent pharmacies; counseling time also seems more comparatively. These different perspectives are because of the differences in the number of chain pharmacies and their authority over the market in different countries.

Contributing to health system's objectives
Although focusing on the profit may lead to the weakened role of pharmacist in the health care within the chain pharmacies and failure in achieving health system goals, by proper regulation and supervision, Chain pharmacies› facilities will be the opportunity to provide health services such as screening programs and training patients towards a better understanding of their health and their own potential needs.

Pharmacy costs
Due to the use of shared resources and economies of scale, costs are mostly reduced, though at times, high expenses in infrastructures or decoration may add up the total costs.

Affecting the economy of independent pharmacies
One can never deny the influence of chain pharmacies as a powerful competitor over the economy of independent pharmacies. In one view, integrating independent pharmacies with low turnover into chain pharmacies can save them; On the other hand, chain pharmacies can lead to more treat for independent pharmacies life.

Patient costs
It is expected to decrease Price of non-prescription and generic drugs and give a discount on generic drugs, which lead to decrease in the consumers' drug expenses. But in many countries this is not the case. Although there is a more bargain power in chain pharmacies, the decrease in the consumer price is dependent upon the monitoring and controlling of pharmacy profit margin.

Health section costs
In chain pharmacies, due to the increase in the market power and monopoly, induced demand will increased, and because of the selling more non-prescription medicines and supplements, the general health system cost is increased.

Conclusion
Due to the economical incentives, Chain pharmacies would not be avoidable and even though the legal limitation, they have been established illegally. As mentioned in this report, Chain pharmacies have some advantages and disadvantages and through a proper regulation and supervision, we can welcome its advantages and reduce disadvantages. Nevertheless, by keeping silent against this illegal phenomenon, society would bear disadvantages while being deprived of its possible advantages.
Mahdi Mohammadzadeh is currently working as assistant Professor of Pharmacoeconomic, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran. He could be reached at the following e-mail address: mohammadzadeh655@yahoo.com